Surgical instruments

ABSTRACT

A surgical instrument that may include a housing, a transducer engaged with the housing which can produce vibrations, and an end-effector engaged with the transducer. The surgical instrument can further include an adjustable sheath extending from the housing where the sheath is movable relative to the distal tip of the end-effector and where the distance between the distal tip of the sheath and the distal tip of the end-effector can be set such that the sheath can act as a depth stop. The sheath can be adjusted such that, when the distal tip of the sheath contacts the tissue or bone being incised, the surgeon can determine that the appropriate depth of the incision has been reached. In other embodiments, the end-effector can be moved with respect to the sheath in order to adjust the distance between the distal tip of the end-effector and the distal tip of the sheath.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application claiming priorityunder U.S.C. §120 from U.S. patent application Ser. No. 13/414,819,entitled SURGICAL INSTRUMENTS, filed on Mar. 8, 2012, now U.S. Pat. No.8,900,259, which is a divisional application claiming priority underU.S.C. §121 from U.S. patent application Ser. No. 11/726,620, entitledSURGICAL INSTRUMENTS, filed on Mar. 22, 2007, now U.S. Pat. No.8,142,461, the entire disclosures of which are hereby incorporated byreference. The present application is also related to the followingcommonly-owned U.S. Patent Applications filed on Mar. 22, 2007, andwhich are hereby incorporated by reference in their entirety:

(1) U.S. patent application Ser. No. 11/726,625, entitled SURGICALINSTRUMENTS, now U.S. Pat. No. 8,911,460;

(2) U.S. patent application Ser. No. 11/726,760, entitled ULTRASONICSURGICAL INSTRUMENTS, now U.S. Pat. No. 8,226,675; and

(3) U.S. patent application Ser. No. 11/726,621, entitled ULTRASONICSURGICAL INSTRUMENTS AND CARTILAGE BONE SHAPING BLADES THEREFOR, nowU.S. Patent Application Publication No. 2008/0234709.

BACKGROUND

1. Field on the Invention

The present invention generally relates to ultrasonic surgicalinstruments and, more particularly, to harmonic scalpels for cuttingbone and for cutting and/or coagulating tissue, for example.

2. Description of the Related Art

Ultrasonic surgical instruments can be used for the safe and effectivetreatment of many medical conditions. Generally, ultrasonic surgicalinstruments can be used to cut and/or coagulate organic tissue, forexample, using energy in the form of ultrasonic vibrations, i.e.,mechanical vibrations transmitted to a surgical end-effector atultrasonic frequencies. These ultrasonic vibrations, when transmitted toorganic tissue at suitable energy levels and using a suitableend-effector, may be used to cut and/or coagulate the tissue. Suchinstruments may be used for open procedures or minimally invasiveprocedures, such as endoscopic or laparoscopic procedures, for example,wherein the end-effector is passed through a trocar to reach a surgicalsite.

Although ultrasonic surgical instruments can perform their intendedfunction remarkably well, the energy and vibrations created by theseinstruments is significant and, if not properly controlled, canunintentionally cause damage to tissue and/or bone surrounding thesurgical site. As a result, several safety features have been developedto prevent, or at least reduce the possibility of, such damage fromoccurring. For example, some surgical instruments have been developedwhich include sheaths that extend around at least a portion of theend-effector. In use, these sheaths can prevent portions of theend-effector from unintentionally contacting tissue or bone surroundingthe surgical site. However, these sheaths can block the surgeon's viewof the surgical site, for example. As a result, the surgeon may not beable to readily ascertain the depth of their incisions and makecorrective adjustments. What is needed is an improvement over theforegoing.

SUMMARY

In at least one form of the invention, a surgical instrument can includea housing, a transducer engaged with the housing where the transducer isconfigured to produce vibrations, and an end-effector engaged with thetransducer. In various embodiments, the end-effector can define an axisand a distal tip where the distal tip is movable along the axis byvibrations produced by the transducer. In at least one embodiment, thesurgical instrument can further include an adjustable sheath extendingfrom the housing where the sheath is movable relative to the distal tipof the end-effector. In these embodiments, the distance between thedistal tip of the sheath and the distal tip of the end-effector can beset such that the sheath can act as a depth stop. More particularly, thesheath can be adjusted such that, when the distal tip of the sheathcontacts the tissue or bone being incised, for example, the surgeon canreadily determine that the appropriate depth of the incision has beenreached. In other various embodiments, the end-effector can be movedwith respect to the sheath in order to adjust the distance between thedistal tip of the end-effector and the distal tip of the sheath.

In at least one form of the invention, a surgical instrument can includea sheath which is removably attached to the housing of the surgicalinstrument. In various embodiments, a kit can be provided which includesa plurality of sheaths where each sheath can have a different lengthand/or configuration. In at least one embodiment, the kit can include afirst sheath and a second sheath where, when the first sheath isassembled to the housing, the distal tip of the end-effector and thedistal tip of the first sheath define a first distance therebetween,and, when the second sheath is assembled to the housing, the distal tipof the end-effector and the distal tip of the second sheath define asecond distance therebetween which is different than the first distance.In these embodiments, a surgeon can select a sheath from the kit suchthat the sheath, when its distal tip contacts the tissue or bone beingincised, for example, allows the surgeon to readily determine that thedesired depth of the incision has been reached.

In at least one form of the invention, a surgical instrument can includea housing, a transducer engaged with the housing where the transducer isconfigured to produce vibrations, and an end-effector engaged with thetransducer. The end-effector can include a first treatment region, asecond treatment region, and at least one indicium or demarcation on theend-effector configured to identify the first treatment region, forexample. In at least one such embodiment, the first treatment region caninclude a cutting edge configured to cut tissue and the second treatmentregion can include an arcuate surface configured to cauterize orcoagulate tissue where the at least one indicium or demarcation canallow a surgeon to readily identify such portions of the end-effector.Similarly, in at least one embodiment, the at least one indicium ordemarcation can be configured to indicate which portions of theend-effector vibrate at a high intensity and which portions vibrate at alow intensity.

In at least one form of the invention, a surgical instrument can includea housing, a transducer engaged with the housing where the transducer isconfigured to produce vibrations, and an end-effector engaged with thetransducer. The end-effector can further include a clamp having a jawmember and a pivot where the jaw member is rotatable with respect to theend-effector between an open position and a closed position about thepivot. In addition, the clamp can be translatable between a firstposition and a second position with respect to the distal tip of theend-effector. In these embodiments, the jaw member can be used, ifdesired, to hold tissue against the end-effector as it is being incised,for example, or, alternatively, the clamp can be translated away fromthe distal tip of the end-effector such that the end-effector can beused without the clamp. Such features allow the surgeon to use oneinstrument to perform various tasks where more than one instrument waspreviously required to perform the same tasks.

BRIEF DESCRIPTION OF THE DRAWINGS

The above-mentioned and other features and advantages of this invention,and the manner of attaining them, will become more apparent and theinvention itself will be better understood by reference to the followingdescription of embodiments of the invention taken in conjunction withthe accompanying drawings, wherein:

FIG. 1 is a perspective view of a ultrasonic surgical instrumentoperably connected to a signal generator;

FIG. 2 is a cross-sectional view of the ultrasonic surgical instrumentof FIG. 1;

FIG. 3 is a perspective view of a surgical instrument in accordance withan embodiment of the present invention;

FIG. 4 is a partial cross-sectional view of the surgical instrument ofFIG. 3 wherein the sheath of the surgical instrument is extended tocover the end-effector;

FIG. 5 is a partial cross-sectional view of the surgical instrument ofFIG. 3 wherein the sheath has been retracted to uncover a portion of theend-effector;

FIG. 6 is an exploded assembly view of the surgical instrument of FIG.3;

FIG. 7 is a perspective view of the ratchet mechanism and sheath of thesurgical instrument of FIG. 3;

FIG. 8 is an exploded assembly view of portions of the ratchet mechanismof FIG. 7;

FIG. 9 is a partial perspective view of portions of the ratchet wheeland pawl of the ratchet mechanism of FIG. 7;

FIG. 10 is a cross-sectional view of the ratchet mechanism of FIG. 7;

FIG. 11 is a partial cross-sectional view of a surgical instrument inaccordance with an alternative embodiment of the present invention;

FIG. 12 is a partial cross-sectional view of the surgical instrument ofFIG. 11 wherein the end-effector has been extended with respect to thesheath;

FIG. 13 is an exploded assembly view of the surgical instrument of FIG.11;

FIG. 14 is a perspective view of the ratchet mechanism of the surgicalinstrument of FIG. 11;

FIG. 15 is a partial exploded assembly view of the sheath, end-effector,and transducer of the surgical instrument of FIG. 11 with some elementsshown in cross-section for clarity;

FIG. 16 is a perspective view of a surgical instrument in accordancewith an alternative embodiment of the present invention having a handleand a relatively rotatable sheath;

FIG. 17 is a plan view of the surgical instrument of FIG. 16 where thesheath is in a fully extended position;

FIG. 18 is a cross-sectional view of the surgical instrument of FIG. 16where the sheath is in a fully extended position;

FIG. 19 is a plan view of the surgical instrument of FIG. 16 wherein thesheath is in a partially retracted position;

FIG. 20 is a plan view of the surgical instrument of FIG. 16 wherein thesheath is in a retracted position;

FIG. 21 is a cross-sectional view of the surgical instrument of FIG. 16where the sheath is in a retracted position;

FIG. 22 is a plan view of a surgical instrument in accordance with analternative embodiment of the present invention having indicia on thesheath to indicate the distance between the distal tip of the sheath andthe distal tip of the end-effector;

FIG. 23 is a partial cross-sectional view of the surgical instrument ofFIG. 22;

FIG. 24 is a perspective view of a surgical instrument in accordancewith an alternative embodiment of the present invention havingrelatively telescoping portions;

FIG. 25 is a cross-sectional view of the surgical instrument of FIG. 24in a fully extended configuration;

FIG. 26 is a cross-sectional view of the surgical instrument of FIG. 24in a partially retracted configuration;

FIG. 27 is a cross-sectional view of the surgical instrument of FIG. 24in a fully retracted configuration;

FIG. 28 is a partial plan view of a surgical instrument in accordancewith an alternative embodiment of the present invention;

FIG. 29 is a cross-sectional view of the surgical instrument of FIG. 28;

FIG. 30 is a schematic of a surgical kit including a surgical instrumentand a plurality of removably attachable sheaths in accordance with analternative embodiment of the present invention;

FIG. 31 is a schematic of a surgical kit including a surgical instrumentand a plurality of removably attachable end-effectors in accordance withan alternative embodiment of the present invention;

FIG. 32 is a partial cross-sectional view of the interconnection betweenan end-effector and the transducer of the surgical instrument of FIG.31;

FIG. 33 is a partial perspective view of a surgical instrument inaccordance with an alternative embodiment of the present inventionhaving a first treatment region and a second treatment region;

FIG. 34 is a partial perspective view of a surgical instrument inaccordance with an alternative embodiment of the present inventionincluding a retractable clamp;

FIG. 35 is a partial cross-sectional view of the surgical instrument ofFIG. 34 where the clamp is in a retracted position;

FIG. 36 is a partial cross-sectional view of the surgical instrument ofFIG. 34 where the clamp is in an extended position;

FIG. 37 is a partial cross-sectional view of the surgical instrument ofFIG. 34 where the jaw member of the clamp has been moved into an openposition;

FIG. 38 is a cross-sectional view of an alternative embodiment of anactuator in accordance with an embodiment of the present inventionoperably configured to extend and retract the clamp of the surgicalinstrument of FIG. 34;

FIG. 39 is a cross-sectional view of an actuator operably configured toextend and retract the clamp of the surgical instrument of FIG. 34;

FIG. 40 is a partial elevational view of the surgical instrument of FIG.34 illustrating a second actuator configured to move the jaw member ofthe surgical instrument between an open and closed position;

FIG. 41 is a cross-sectional view of the surgical instrument of FIG. 34illustrating the second actuator of FIG. 40;

FIG. 42 is an exploded perspective view of the clamp of the surgicalinstrument of FIG. 34;

FIG. 43 is an exploded perspective view of the connection between theclamp of FIG. 42 and the actuators of FIGS. 39 and 40;

FIG. 44 is an exploded assembly view of portions of the connector ofFIG. 43;

FIG. 45 is an exploded assembly view of a surgical instrument inaccordance with an alternative embodiment of the present inventionhaving a removably attachable jaw member;

FIG. 46 is a perspective view of the surgical instrument of FIG. 45;

FIG. 47 is a perspective view of the clamp of the surgical instrument ofFIG. 45 where the jaw member is in an open position and where somecomponents are shown in cross-section for clarity;

FIG. 48 is a partial perspective view of the clamp of the surgicalinstrument of FIG. 45 in a retracted position;

FIG. 49 is a perspective view of the jaw member of FIG. 45;

FIG. 50 is a second perspective view of the jaw member of FIG. 45;

FIG. 51 is a perspective view of a removably attachable jaw member inaccordance with an alternative embodiment of the present invention; and

FIG. 52 is a second perspective view of the jaw member of FIG. 51.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate preferred embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

As indicated above, ultrasonic surgical instruments can be used to cut,cauterize, and/or coagulate organic tissue, for example, using energy inthe form of ultrasonic vibrations, i.e., mechanical vibrationstransmitted to a surgical end-effector at ultrasonic frequencies.Examples of ultrasonic surgical instruments are disclosed in U.S. Pat.Nos. 5,322,055, 5,954,736, 6,278,218, 6,283,981, 6,309,400, and6,325,811, the disclosures of which are incorporated by reference hereinin their entirety. In various embodiments, an ultrasonic signalgenerator can be provided which produces a desired electrical signal andcan be connected to a handpiece of the surgical instrument by a cable. Asuitable generator is available as model number GEN04, from EthiconEndo-Surgery, Inc., Cincinnati, Ohio. In one embodiment, referring toFIG. 1, the electrical signal, i.e., the drive current, can betransmitted from generator 10 to hand piece 12 through cable 14.

Referring to FIG. 2, handpiece 12 can include transducer 18 comprisingpiezoceramic elements 16, for example, which can be configured toconvert the drive current into mechanical vibrations. More particularly,the drive current can cause disturbances in elements 16 in the form ofrepeated displacements which can, in turn, cause elements 16 to expandand contract in a continuous manner along a voltage gradient, or axis,producing longitudinal waves of ultrasonic energy along this axis. Invarious embodiments, elements 16 can produce vibrations transverse to,or in a torsional manner about, the longitudinal axis. Piezoceramicelements 16 can be fabricated from any suitable material such as leadzirconate-titanate, lead meta-niobate, lead titanate, or otherpiezoelectric crystal materials, for example. In various embodiments,elements 16 can include magnetostrictive elements including, forexample, alloys comprised of iron, cobalt and rare earth elementsincluding nickel, vanadium, dysprosium, and terbium. Magnetostriction isa property of ferromagentic materials that causes the materials tochange shape when they are subjected to a magnetic field.Magnetostrictive elements are further described in U.S. Pat. No.7,157,058, the disclosure of which is incorporated by reference hereinin its entirety. In any event, transducer 18 can be comprised of anymechanism or material which can produce the required vibratory motion toend-effector 22 as described below.

In use, the longitudinal waves created by transducer 18 can producelongitudinal vibratory movement of waveguide 20 and end-effector 22mounted thereto. In at least one embodiment, the drive current caninclude an alternating current defined by a substantially sinusoidalfrequency which, owing to the excitation of elements 16 described above,causes waveguide 20 and end-effector 22 to vibrate longitudinally in asubstantially sinusoidal manner. In various embodiments, transducer 18can be configured such that waveguide 20 and end-effector 22 arevibrated at a preselected resonant frequency. In at least one suchembodiment, piezoceramic elements 16 can be driven at ultrasonicfrequencies including frequencies between approximately 50,000 andapproximately 60,000 cycles per second, for example. In otherembodiments, elements 16 can be driven at frequency greater than orequal to approximately 20,000 cycles per second. In addition to theabove, the magnitude of the drive current voltage can dictate themagnitude of the displacement of end-effector 22.

When piezoceramic elements 16 are energized, a vibratory motion standingwave is generated through transducer 18, waveguide 20 and end-effector22. The amplitude of the vibratory motion at any point along thesecomponents may depend upon the location at which the vibratory motion ismeasured. For example, at some locations along wave guide 20 andend-effector 22, the vibratory motion may be at a higher intensity oramplitude and, at other locations, at a lower intensity or amplitude. Atsome locations, the vibratory motion is zero, or substantially zero. Aminimum or zero point in the vibratory motion standing wave is generallyreferred to as a node whereas a maximum or peak in the standing wave isgenerally referred to as an anti-node. The distance between an anti-nodeand an adjacent node is approximately one-quarter wavelength of thestanding wave frequency, i.e., λ/4. These nodal locations alsocorrespond to the relative maximum stress locations in the systemwhereas the anti-nodes correspond to relative minimum stress locations.

In order to transmit the standing wave from transducer 18 to waveguide20, waveguide 20 must be acoustically coupled to transducer 18, i.e.,they must be attached in such a way that mechanical vibrations producedby transducer 18 are transmitted into wave guide 20. Similarly, in orderto transmit these vibrations to the distal tip of end-effector 22,waveguide 20 and end-effector 22 must also be acoustically coupled ifmanufactured as separate components. In preferred embodiments, suchcouplings are configured to substantially coincide with the anti-nodesof the standing wave such that little, if any, vibratory stress ispresent at the couplings. In these embodiments, as a result, thepossibility of transducer 18, waveguide 20 and end-effector 22 becomingdecoupled is reduced.

In various embodiments, transducer 18, waveguide 20 and end-effector 22can comprise an assembly which can be driven at, or close to, itsresonant, or natural, frequency and amplify the motion initiated bytransducer 18. In the illustrated embodiment, end-effector 22 comprisesa blade which is integral with waveguide 20 and can be constructed froma material suitable for transmission of ultrasonic energy such as, forexample, Ti6Al4V (an alloy of titanium including aluminum and vanadium),aluminum, stainless steel, or other known materials. Alternately, blade22 may be manufactured as a separate component and can be comprised of adifferent material than waveguide 20, for example. In these embodiments,blade 22 and waveguide 20 can be coupled by a stud, a threadedconnection or by any suitable process including welding, gluing, orother known methods, for example. In various embodiments, at leastportions of the waveguide, blade and transducer can be comprised of acontinuous material

In order to operate the ultrasonic surgical system in an efficientmanner, the frequency of the signal supplied to transducer 18 can beswept over a range of frequencies to locate the resonance frequency. Inat least one embodiment, a switch, such as switch 24, on hand piece 12can be manipulated to activate the signal sweep. Once the resonancefrequency is found, generator 10 can lock onto the resonance frequency,monitor the transducer current to voltage phase angle, and adjust thedrive current such that it drives the waveform and blade assembly at, orclose to, the resonance frequency. In at least one embodiment, once thegenerator has locked onto the resonant frequency, an audio indicator,for example, can be communicated to the user to indicate the same. Oncethe resonant frequency of the system has been determined, the drivecurrent can be immediately supplied to hand piece 12 and/or the drivecurrent may be controlled by the operation of switch 24 located thereon,for example. In other embodiments, the drive current may be controlledby foot switch 26 which is connected to generator 10 by cable 28.

Referring to FIG. 3, surgical instrument 50 can include housing 52,end-effector 54 and adjustable sheath 56. In use, sheath 56 can act as adepth stop when a surgeon is incising tissue or bone, for example. Moreparticularly, as the surgeon inserts end-effector 54 into the tissue orbone, the surgeon can force end-effector 54 therein until distal tip 57of sheath 56 contacts the surface thereof. Once distal tip 57 of sheath56 has contacted the surface of the tissue or bone, the surgeon willknow that distal tip 55 of end-effector 54 has reached the desired depththerein. As a result, the likelihood of the surgeon insertingend-effector 54 into the tissue or bone beyond the desired depth isreduced. This feature is particularly useful in applications where thesurgeon is required to plunge end-effector 54 into the tissue or bone.In one such embodiment, a surgeon may be required to create a pilot holein a bone, such as a vertebral body, for example, before a screw isinserted into the bone. In various embodiments, sheath 56 can alsosubstantially prevent end-effector 54 from accidentally contacting thetissue or bone surrounding the surgical site. Although sheath 56 isillustrated as entirely surrounding the perimeter of end-effector 54,other embodiments are envisioned where sheath 56 only partiallysurrounds the perimeter of end-effector 54.

In various embodiments, as discussed in further detail below, theposition of sheath 56 can be adjusted to change the distance betweendistal tip 55 of end-effector 54 and distal tip 57 of sheath 56. In atleast one such embodiment, referring to FIGS. 4 and 5, sheath 56 can beoperably engaged with actuator 58 such that, when actuator 58 isoperated, distal tip 57 of sheath 56 is moved away from distal tip 55 ofend-effector 54, for example. More particularly, referring to FIGS. 3-8which illustrate the present embodiment, surgical instrument 50 caninclude ratchet mechanism 60 which, when operated by actuator 58, canmove sheath 56 proximally with respect to distal tip 55 of end-effector54 and uncover a treatment portion thereof. As a result, a surgeon, orother clinician, for example, may adjust the position of sheath 56 tosuit the needs of a particular application by setting the distancebetween distal end 55 and distal end 57 such that end-effector 54 doesnot incise the tissue or bone deeper than desired.

Referring primarily to FIGS. 4-7, sheath 56 can be mounted to rack 62via collar 64. In the present embodiment, sheath 56 can be fixedlyretained, or press-fit, within slot 66 of collar 64 such there issubstantially no relative translational or rotational movementtherebetween. More particularly, sheath 56 can include flange 59 whichis configured to be slid into slot 66 and retain sheath 56 to collar 64.In other embodiments, however, sheath 56 and collar 64 can be configuredto permit relative rotational movement therebetween, for example.Referring to FIG. 6, collar 64 can include projections 68 extendingtherefrom which are sized and configured to be slidably retained withinslots 53 of housing 52. As a result of projections 68, when rack 62 ismoved relative to housing 52, as discussed in greater detail below,slots 53 can define the path of rack 62. In the present embodiment,slots 53 define a substantially linear path such that rack 62 is movedalong, or parallel to, an axis defined by end-effector 54, i.e., axis 51(FIG. 5). However, in other various embodiments, other paths, includingnon-linear paths, are contemplated.

In order to move rack 62 relative to housing 52, in the presentembodiment, actuator 58 can be engaged with ratchet mechanism 60 suchthat, when actuator 58 is moved toward handle 60, ratchet mechanism 60slides rack 62 proximally with respect to distal tip 55 of end-effector54. Referring primarily to FIGS. 7 and 8, ratchet mechanism 60 caninclude ratchet wheel 61, pawl 63, and drive gear 65. In the presentembodiment, ratchet wheel 61 can include gear face 67 which isconfigured to engage gear face 70 of actuator 58 such that, whenactuator 58 is moved toward handle 60, gear faces 67 and 70 driveratchet wheel 61 about axis 69 (FIG. 8). In at least one embodiment,gear faces 67 and 70 can include teeth which are configured to meshtogether when actuator 58 is rotated toward handle 60, as describedabove, but are also configured to permit relative sliding movementtherebetween when actuator 58 is rotated in the opposite direction. Moreparticularly, after actuator 58 has been brought into close oppositionto handle 60, gear faces 67 and 70 can be configured such that, whenactuator 58 is released, spring 74 can pull actuator 58 back into itsstarting position by dragging gear face 70 across gear face 67. Afteractuator 58 has been repositioned by spring 74, actuator 58 can again bepulled toward handle 60 to further rotate ratchet wheel 61.

Referring to FIG. 8, ratchet wheel 61 can be fixedly mounted to driveshaft 72 such that, when ratchet wheel 61 is rotated about axis 69 byactuator 58, drive shaft 72 is also rotated about axis 69. Drive gear 65can also be fixedly mounted to drive shaft 72 such that, when ratchetwheel 61 is rotated, drive shaft 72 rotates drive gear 65. Referringprimarily to FIG. 6, drive gear 65 can be operably engaged with largegear 71 such that the rotation of drive gear 65 rotates large gear 71.Large gear 71 can be fixedly mounted to pinion gear 73 via shaft 75 suchthat the rotation of large gear 71 rotates pinion gear 73. Referring toFIG. 6, pinion gear 73 can be operably engaged with rack 62 such that,when actuator 58 is operated, the gear train comprising drive gear 65,large gear 71 and pinion gear 73 is operated to slide rack 62 proximallyas described above.

Referring to FIGS. 8 and 9, when actuator 58 is brought into closeopposition to handle 60 and then released, as described above, pawl 63can be configured to hold ratchet wheel 61 in position as actuator 58 isreturned to its starting position. More particularly, ratchet wheel 61can include teeth 78 which are configured to permit pawl 63 to slidethereover as actuator 58 is moved toward handle 60 and which areconfigured to mesh with pawl 63 when actuator 58 is moved in theopposite direction. As a result, ratchet wheel 61 can be rotated byactuator 58 to withdraw sheath 56 without interference from pawl 63,however, pawl 63 can prevent ratchet wheel 61 and sheath 56 fromsubstantially moving as actuator 58 is reset, as described above. Oncethe position of sheath 56 has been selected, pawl 63 can also holdratchet wheel 61 in position as surgical instrument 50 is manipulatedand operated in the surgical site.

To move sheath 56 distally toward distal end 55 of end-effector 54,ratchet mechanism 60 can include a release mechanism which disengagespawl 63 from ratchet wheel 61. More particularly, referring to FIGS. 5-9and primarily FIG. 10, surgical instrument 50 can further includeplunger 80 which extends from actuator 58 and is engaged with ratchetwheel 61 such that when plunger 80 is depressed, ratchet 61 is movedaway from pawl 63. Referring to FIG. 10, pawl 63 can include bevelsurface 81 which is configured to permit pawl 63 to slide on top ofratchet wheel 61 and allow pawl 63 to be disengaged from teeth 78. Oncepawl 63 has been disengaged from teeth 78, sheath 56 can be freelymanipulated without interference from ratchet mechanism 60. As a result,the surgeon can move sheath 56 such that it covers distal tip 55 ofend-effector 54, or to any other position. In the present embodiment,surgical instrument 50 can include return spring 84 (FIGS. 4-7) whichcan automatically reposition sheath 56 over distal tip 54 after plunger80 has been depressed. After sheath 56 has been repositioned, thesurgeon may release plunger 80 and allow plunger return spring 86 toreset plunger 80 and, accordingly, allow pawl 63 to reengage ratchetwheel 61.

As described above, a surgeon can use distal end 57 of sheath 56 as adepth stop. In use, the surgeon can select the distance between distalend 57 of sheath 56 and distal end 55 of end-effector 54 such thatdistance between distal ends 55 and 57 equals the depth to which thesurgeon desires to incise the tissue or bone. To assist the surgeon indetermining the distance between distal end 55 and distal end 57,surgical instrument 50 can include depth indicator 88. Moreparticularly, referring to FIGS. 3-5, depth indictor 88 can be mountedto rack 62 such that, as rack 62, and, correspondingly, sheath 56, aremoved relative to distal end 55 of end-effector 54, depth indicator 88co-operates with indicia 89 on housing 52 to display the distancebetween distal tip 57 of sheath 56 and distal tip 55 of end-effector 54.In various embodiments, as a result of manufacturing tolerances, thisdistance may be approximate; however, care can be taken to reduce impactthereof by controlling and accounting for these tolerances, as known inthe art.

In the present embodiment, transducer 90 can be mounted to housing 52 asknown in the art. In alternative embodiments, referring to surgicalinstrument 150 illustrated in FIGS. 11-15, transducer 90 can be mountedto rack 162 such that transducer 90 can be moved relative to housing152. In these embodiments, the distance between distal tip 55 ofend-effector 54 and distal tip 57 of sheath 56 can be adjusted by movingend-effector 54 and transducer 90 relative to sheath 56. In suchembodiments, referring to FIG. 13, sheath 56 can be mounted to housing152 via flange 59 and slot 166 and transducer 90 can be mounted withinaperture 191 of collar 164. Surgical instrument 150 can also includeratchet mechanism 160 for moving end-effector 54 relative to distal end57 or sheath 56. Notably, referring primarily to FIG. 14, the gear trainof ratchet mechanism 160 includes one gear more than ratchet mechanism60, i.e., gear 177, and, as a result, operation of actuator 58 causesrack 162 to advance distally instead of withdrawing proximally asdescribed in the embodiments above. Furthermore, surgical instrument 150can include return spring 184 which is configured retract rack 162 andend-effector 54. Return spring 184, in the present embodiment, includesa flexible band 185 which is attached to rack 162 and is elasticallybiased such that return spring 184 is configured to retract and coilflexible band 185 therein.

In various embodiments of the present invention, a surgical instrumentcan include a sheath which is rotatably extendable and/or retractablewith respect to the housing of the surgical instrument. Referring toFIGS. 16-21, surgical instrument 200 can include housing 252,end-effector 254, and sheath 256. Housing 252 and sheath 256 can includethreads 292 and 293, respectively, which are threadably engaged suchthat one of housing 252 and sheath 256 can be rotated with respect tothe other to extend or retract distal end 257 of sheath 256 with respectto distal end 255 of end-effector 254. In various embodiments, threads292 and 293 may be comprised of fine-pitch threads which hold therelative position of housing 252 and sheath 256 in a substantially fixedposition. However, in various other embodiments, although notillustrated, surgical instrument 200 may include features for morepositively securing the relative position of housing 252 and sheath 256.In at least one such embodiment, surgical instrument 200 can include acollar which is threaded over at least a portion of housing 252 andsheath 256 to fixedly retain them in position.

In various embodiments, the surgical instrument can include, referringto FIGS. 22 and 23, indicia 389 and depth gauge 388 which, similar tothe above, can be used by a surgeon to evaluate the distance betweendistal end 357 of sheath 356 and distal end 355 of end-effector 354.More particularly, in the present embodiment, the distal edge of housing352, i.e., depth gauge 388, can be used by the surgeon as a datum bywhich indicia 389 are evaluated. As described above, once the distancebetween distal ends 355 and 357 has been set, end-effector 354 can beinserted into the tissue of bone, for example, until distal end 357 ofsheath 356 contacts the tissue or bone. In various embodiments, distalend 357 can comprise a flared, or bell-shaped, end which can beconfigured to push tissue surrounding the surgical site, for example,away from end-effector 354 to prevent accidental injury thereto.

In various embodiments of the present invention, a surgical instrumentcan include a sheath comprising two or more telescoping portions.Referring to FIGS. 24-27, surgical instrument 400 can include housing452, end-effector 454, and sheath 456. In at least one embodiment,housing 452 can comprise an outer portion and sheath 456 can includeintermediate portion 494 and inner portion 495. Similar to the above,intermediate portion 494 can be threadably engaged with and rotatedrelative to housing 452 and inner portion 495 can be threadably engagedwith and rotated relative to intermediate portion 494 in order to extendand/or retract distal end 457 of sheath 456 with respect to distal end455 of end-effector 454. In various embodiments, intermediate portion494 and inner portion 495 can include distal and/or proximal stops whichcan limit the relative movement therebetween. In at least oneembodiment, surgical instrument 400 can include seals 496, such asrubber O-rings, for example, which seal gaps between housing 452,intermediate portion 494 and outer portion 495.

In various embodiments of the present invention, a surgical instrumentcan include at least two relatively collet-like slidable portions and acollar, for example, for fixedly securing the slidable portionstogether. More particularly, referring to FIGS. 28 and 29, surgicalinstrument 500 can include housing 552, sheath 556, and collar 597. Inuse, a surgeon can slide sheath 556 within housing 552 to position,similar to the above, the distal end of sheath 556 with respect to thedistal end of the end-effector. Thereafter, the surgeon may threadcollar 597 onto the threaded end of housing 552 to compress housing 552against the outside surface of sheath 556 positioned therein. As aresult of this compression, the relative position of housing 552 andsheath 556 can be substantially fixed and prevented from slidingrelative to each other. In at least one embodiment, referring to FIG.28, the threaded end of housing 552 can include slits 579 which dividethe threaded end of housing 552 into independently deflectable portionswhich can be more easily displaced by collar 597. In various otherembodiments, although not illustrated, housing 552 can be configured toslide within sheath 556 and collar 597 can be configured to compresssheath 556 against housing 552.

In various embodiments of the present invention, a surgical instrumentcan include a detachable sheath. More particularly, in at least oneembodiment, referring to FIG. 30, a kit can be provided to a surgeoncontaining surgical instrument 600 having housing 652 and end-effector654, and a plurality of sheaths having different lengths and/orconfigurations, for example. In the illustrated embodiments, the kit caninclude sheaths 656 a, 656 b, 656 c and 656 d, wherein each sheath has adifferent length. In use, a surgeon can select a sheath 656 from the kitthat provides a desired distance between distal tip 655 of end-effector654 and the distal tip 657 of the selected sheath 656. As a result, thesurgeon can control the depth to which end-effector 654 is inserted intotissue or bone, for example, by selecting the appropriate sleeve 656. Tofacilitate the attachment of the selected sheath 656 to housing 652,each sheath 656 can include at least one slot 683 which can be sized andconfigured to receive a projection 687 extending from housing 652 andretain the sheath thereto. In various embodiments, each slot 683 can beconfigured to receive a projection 687 in press-fit engagement, forexample, to assure a secure fit therebetween. In the illustratedembodiments, slots 683 are L-shaped such that the sheath 656 can be‘twist-locked’ onto housing 652. Although not illustrated, the sheathscan include projections extending therefrom and housing 652 can includeslots configured to receive the projections, or any combination thereof.Furthermore, although not illustrated, the sheath can be comprised ofseveral portions. In at least one such embodiment, the sheath cancomprise an adapter attached to the housing where the adapter isconfigured to removably receive one of several different end-portions.In various embodiments, the sheath can include several portions whichare selectively joined together to adjust the overall length of thesheath.

In various embodiments of the present invention, a surgical instrumentcan include a detachable end-effector. More particularly, in at leastone embodiment, referring to FIG. 31, a kit can be provided to a surgeoncontaining surgical instrument 700 having housing 752 and sheath 756,and a plurality of end-effectors having different lengths and/orconfigurations, for example. In the illustrated embodiment, the kit caninclude end-effectors 754 a, 754 b, 754 c and 754 d, wherein eachend-effector has a different length. In use, a surgeon can select anend-effector 754 from the kit that provides a desired distance betweendistal tip 757 of sheath 756 and the distal tip 755 of the selectedend-effector 754. As a result, the surgeon can control the depth towhich end-effector 754 is inserted into tissue or bone, for example, byselecting the appropriate end-effector 754. To facilitate the attachmentof the selected end-effector 754 to transducer 790, referring to FIG.32, each end-effector 754 can include a threaded recess 798 which isconfigured to receive a threaded portion of transducer 790 or a threadedfastener 799 extending therefrom.

In various embodiments of the present invention, a surgical instrumentcan include an end-effector having at least one indicium or demarcationwhich is configured to identify a treatment region of the end-effector.More particularly, the end-effector can, referring to FIG. 33, includefirst and second treatment regions, for example, which can be used by asurgeon to treat tissue, for example. In at least one such embodiment,end-effector 854 can include first treatment region 830 and secondtreatment region 831, where first treatment region 830 includes acutting edge for incising tissue, for example, and second treatmentregion 831 includes an arcuate surface for cauterizing or coagulatingtissue, for example. Referring to FIG. 33, surface 833 of secondtreatment region 831 can include an indicium or demarcation that allowsa surgeon to more easily identify second treatment region 831 and, bynegative implication, first treatment region 830. In alternativeembodiments, first treatment region 830 may include at least oneindicium or demarcation that is different than the indicium ordemarcation identifying second treatment region 831.

In various embodiments, the indicium may include a coated surface. Suchcoating can be applied by conventional methods including annodization,for example. In embodiments where both first treatment region 830 andsecond treatment region 831 are coated, the coatings can have differentcolors, textures, thicknesses and/or be comprised of differentmaterials, for example. In various embodiments, one of the treatmentregions may be dyed such that it has a different color than the othertreatment region. In at least one embodiment, a treatment region havinga cutting edge or surface may be coated or dyed with a material having abright color, such as red, orange or yellow, for example. Similarly, atreatment region having a surface for cauterizing or coagulating tissuemay be coated or dyed with a material having a dark color such as green,blue or indigo, for example. In various embodiments, at least one of thesurfaces of first treatment region 830 and second treatment region 831can have a modified surface finish. In at least one such embodiment, atleast a portion of the surface can be etched or bead-blasted, forexample, to create a textured surface finish. In embodiments where bothtreatment regions are etched, for example, the degree of etching may bedifferent to allow the surgeon to more readily distinguish between thetreatment regions. In at least one embodiment, the indicium can includenumbers, letters or symbols printed thereon or engraved therein.

In various embodiments, the demarcation may include at least one groovein the surface of the end-effector which can provide delineation betweenthe treatment regions. In at least one embodiment, the entire surface ofa treatment region can include a plurality of grooves that may, invarious embodiments, be arranged in an organized pattern of hatching,for example. In at least one embodiment, the first and second treatmentregions can both include grooves or other demarcations where the densityof the grooves or demarcations can be different in the first treatmentregion than in the second treatment region. In various embodiments, thedensity of the demarcations can include gradual changes which can beconfigured indicate changes in the intensity or amplitude of vibrations,for example, along the length of the end-effector. As a result of suchchanges in the demarcations, a surgeon can readily discern portions ofthe end-effector vibrating at maximum and minimum intensities andintensities therebetween. In at least one such embodiment, the densityof pigmentation, for example, on an end-effector can be greatest at anode, or anti-node, for example, and gradually decrease at increasingdistances from the node, or anti-node. In various embodiments, the rateof change in the density of pigmentation, for example, can be linear or,in other embodiments, it can be geometric. Embodiments having ageometric rate of change in the demarcations can, in at least someembodiments, more accurately represent the change in the intensity ofthe vibrations caused by the standing sinusoidal wave. Although theembodiments outlined above have been described as having first andsecond treatment regions, the present invention is not so limited. Onthe contrary, the end-effector may include more than two treatmentregions each having at least one indicium and/or demarcation or noindicium or demarcation at all.

Further to the above, in various embodiments, at least one indicium ordemarcation can be used to identify portions of the end-effector whichhave either high or low vibrational intensities or amplitudes, forexample. More particularly, as described above, the transducer of thesurgical instrument can generate a standing wave in the end-effectorwhich creates nodes and anti-nodes along the length of the end-effector.These nodes and anti-nodes represent high and low regions of vibrationalintensity, respectively, of the end-effector which can be utilized by asurgeon. For example, the high intensity regions of the end-effector canbe used to incise or cauterize tissue, for example, whereas the lowintensity regions of the end-effector can be used to safely contact thetissue surrounding the surgical site. As these nodes and anti-nodes aretypically indiscernible to the surgeon, an indicium or demarcation maybe provided on the end-effector to allow the surgeon to readily discernthese regions of the end-effector.

In various embodiments of the present invention, a surgical instrumentcan include a retractable clamp configured to hold at least a portion ofa bone or tissue, for example, against the end-effector of the surgicalinstrument. In at least one embodiment, the clamp, when it is extended,can be configured to act as a rongeur or kerrison, for example,configured to hold at least a portion of a bone against the end-effectorto remove small portions of the bone. The clamp, when it is at leastpartially retracted, can allow the end-effector to be used as anultrasonic cobb or curette to dissect tissue or elevate the tissue froma bone, for example. In addition, the end effector can, when the clampis at least partially retracted, be used as an osteotome and can be usedto chisel or resect bone without the use of ultrasonic energy.

In various embodiments, referring generally to FIGS. 34-44, surgicalinstrument 900 can include end-effector 954 and retractable clamp 935.Referring primarily to FIGS. 35-37, retractable clamp 935 can includejaw member 936 and pivot 937 where pivot 937 provides an axis aboutwhich jaw member 936 can be rotated. Retractable clamp 935 can beconnected to outer member 938 which can, as described in greater detailbelow, be operably engaged with a first actuator. In use, the firstactuator can be configured to move clamp 935 between its retractedposition illustrated in FIG. 35 and its extended position in FIG. 36.Once extended, jaw member 936 can be rotated about pivot 937, asillustrated in FIG. 37, so that jaw member 936 can be placed on one sideof a bone or tissue and end-effector 954 can be placed on the oppositeside of the bone or tissue. Jaw member 936 can then be closed onto thebone or tissue and the ultrasonic energy transmitted to end-effector 954from the transducer can be used to cut or seal the bone or tissuetherebetween. As discussed in greater detail below, jaw member 936 canalso be engaged with inner member 939 via drive pin 940 where innermember 939 and drive pin 940 can be configured to rotate jaw member 936about pivot 937.

In various embodiments, referring to FIG. 39, surgical instrument 900can further include first actuator 941. As indicated above, firstactuator 941 can be operably engaged with outer member 938 and can beconfigured to extend or retract clamp 935. More particularly, referringto FIG. 39, first actuator 941 can include plungers 942 which can bebiased into engagement with housing 952 by springs 943 in order to holdouter member 938 in one of several predetermined positions. For example,when plungers 942 are engaged and retained with recesses 944 in housing952, clamp 935 can be in its extended position as illustrated in FIG.35. In order to move clamp 935 into at least a partially extendedposition, plungers 942 can be depressed to disengage them from recesses944 and allow outer member 938, and clamp 935, to be moved distally.Similar to the above, clamp 935 can be held and retained in position,including its fully extend position illustrated in FIG. 35, whenplungers 942 are engaged with other recesses of housing 952. Althoughonly a few sets of recesses are illustrated in FIG. 39, several sets ofrecesses or other retention features, referring to FIG. 38, can be usedto retain outer member 938, and clamp 935, in position. In order toretract outer member 938 and clamp 935, plungers 942 can be depressedand moved proximally.

In various embodiments, referring to FIGS. 40 and 41, surgicalinstrument 900 can further include second actuator 945. Second actuator945 can be operably engaged with inner member 939 and can be configuredto move, or rotate, jaw member 936 about pivot 937 as described above.More particularly, second actuator 945 can include lever 946 and linkage947 which operably connects lever 946 and inner member 939. In use,referring to FIG. 41, lever 946 can be moved from an open position,i.e., its position illustrated in dashed lines in FIG. 41, and a closedposition, i.e., its position illustrated in solid lines. In its openposition, lever 946 and linkage 947 are configured to retain jaw member936 in its open position, i.e., its position illustrated in FIG. 37. Aslever 946 is moved into its closed position, linkage 947 is configuredto retract inner member 939 and close jaw member 936, i.e., bring itinto close opposition to distal end 955 of end-effector 954. To reopenjaw member 936, lever 946 is moved into its open position describedabove.

In various embodiments, referring to FIGS. 42-44, clamp 935 can bedisassembled from surgical instrument 900. More particularly, in atleast one embodiment, outer member 938 and inner member 939 can eachinclude two portions which can be disconnected such that clamp 935 canbe removed. Referring to FIGS. 42 and 43, outer member 938 can includedistal portion 938 a and proximal portion 938 b which, referring to FIG.44, can include connector portions to form a bayonet connectiontherebetween. Similarly, inner member 939 can include distal portion 939a and proximal portion 939 b which also include connector portions toform a bayonet connection therebetween. Thus, in order to attach clamp935 to surgical instrument 900, the respective portions of inner member939 and outer member 938 are aligned and then rotated to secure themtogether. Correspondingly, to remove clamp 935, clamp 935 is rotatedsuch that distal portions 938 a and 939 a become detached from proximalportions 938 b and 939 b.

In various embodiments, referring to FIGS. 45-50, the retractable clampof the surgical instrument can include a detachable jaw member. Moreparticularly, surgical instrument 1100 can include retractable clamp1154 which comprises pivot 1137, jaw connector 1148 and detachable jawmember 1136. Jaw member 1136 can include deflectable legs 1149, forexample, which are configured to be received within recess 1127 of jawconnector 1148. In use, deflectable legs 1149 can be squeezed togetherbefore they are inserted into recess 1127 and then released to allowlegs 1149 to spring outwardly and position feet 1129 behind the walls ofrecess 1127. In at least one embodiment, feet 1129 can include a beveledsurface which can cooperate with the walls of recess 1127 to flex legs1149 inwardly as they are being inserted therein. Furthermore, invarious embodiments, feet 1129 can further include a flat surface, orother contoured surface, which, once feet 1129 are positioned behind thewalls for recess 1127, cooperate with recess 1127 to retain detachablejaw member 1136 to jaw connector 1148.

In use, a surgeon may be provided with a kit comprising surgicalinstrument 1100 and a plurality of jaw members. The surgeon may select adesired jaw member from the plurality of jaw members and attach theselected jaw member to surgical instrument 1100 as described above.Thereafter, the surgeon may use the same surgical instrument 1100 with adifferent jaw member, such as jaw member 1236 illustrated in FIGS. 51and 52, for example, if desired. To detach jaw member 1136, the surgeonmay squeeze legs 1149 together to disengage feet 1129 from recess 1127such that legs 1149 can pass through recess 1127 and jaw member 1136 canbe removed therefrom. Although not illustrated, other attachment meanscan be used to retain the jaw member to the jaw connector such as apress-fit connection or fasteners, for example.

As described above, a surgical instrument having a retractable clamp canbe used for at least three purposes. The first purpose can be to use theclamp to hold tissue or bone against an end-effector where ultrasonicenergy applied to the end-effector can be used to cut the tissue or bonetherebetween. The second purpose can be to at least partially retractthe clamp so that the end-effector can be used to incise or elevatetissue from bone, for example, via ultrasonic energy applied to theend-effector. The third purpose can be to, again, at least partiallyretract the clamp so that the end-effector can be used withoutultrasonic energy applied thereto. In these circumstances, theend-effector can be used to chisel bone, for example, by striking theend of the surgical instrument with a mallet. In various embodiments, anend-effector configured to incise tissue with ultrasonic energy may beunsuitable for striking bone and, as a result, such an end-effector canbe replaced with an end-effector more resembling the end of a chisel,for example.

While several embodiments of the invention have been described, itshould be apparent, however, that various modifications, alterations andadaptations to those embodiments may occur to persons skilled in the artwith the attainment of some or all of the advantages of the invention.For example, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Thisapplication is therefore intended to cover all such modifications,alterations and adaptations without departing from the scope and spiritof the disclosed invention as defined by the appended claims.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device may be reconditioned for reuse after at leastone use. Reconditioning can include a combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular elements, and subsequent reassembly. In particular, thedevice may be disassembled, and any number of particular elements orcomponents of the device may be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice may be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those of ordinary skill in the art will appreciate that thereconditioning of a device may utilize a variety of different techniquesfor disassembly, cleaning/replacement, and reassembly. Use of suchtechniques, and the resulting reconditioned device, are all within thescope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First a new or used instrument is obtained and, if necessary,cleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK® bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or higher energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical instrument, comprising: a transducerconfigured to produce vibrations; an end effector operably engaged withsaid transducer, wherein said end effector defines an axis and a distaltip, wherein said distal tip is movable relative to said axis by saidvibrations produced by said transducer; a clamp member, comprising: afirst connection portion; and a second connection portion spaced apartfrom said first connection portion; an inner tubular member comprising aproximal inner portion and a distal inner portion, wherein said proximalinner portion and said distal inner portion are configured to be coupledto and decoupled from each other, wherein said proximal inner portioncomprises a first inner mating member and a second inner mating memberspaced apart from said first inner mating member, wherein said distalinner portion comprises a third inner mating member and a fourth innermating member spaced apart from said third inner mating member, whereinsaid first inner mating member is releasably coupled to said third innermating member, wherein said second inner mating member is releasablycoupled to said fourth inner mating member; an outer tubular membercomprising a proximal outer portion and a distal outer portion, whereinsaid proximal outer portion and said distal outer portion are configuredto be coupled to and decoupled from each other, wherein said proximalouter portion comprises a first outer mating member and a second outermating member spaced apart from said first outer mating member, whereinsaid distal outer portion comprises a third outer mating member and afourth outer mating member spaced apart from said third outer matingmember, wherein said first outer mating member is releasably coupled tosaid third outer mating member, and wherein said second outer matingmember is releasably coupled to said fourth outer mating member; and aconnector assembly, comprising: a first connector; and a secondconnector, wherein said first connector is configured to releasably andmovably couple said first connection portion of said clamp member tosaid outer tubular member, and wherein said second connector isconfigured to releasably and movably couple said second connectionportion of said clamp member to said inner tubular member.
 2. Thesurgical instrument of claim 1, wherein said vibrations include at leastone of vibrations parallel to said axis, vibrations transverse to saidaxis, and vibrations torsional about said axis.
 3. The surgicalinstrument of claim 1, wherein said clamp member further comprises a jawmember moveably supported relative to said end effector, wherein saidjaw member is moveable between an open position and a closed position.4. The surgical instrument of claim 3, wherein relative movement betweensaid inner tubular member and said outer tubular member causes said jawmember to rotate about a pivot.
 5. The surgical instrument of claim 1,wherein said outer tubular member includes a cavity extendingtherethrough, and wherein said inner tubular member is configured to bereceived within said outer tubular member.
 6. The surgical instrument ofclaim 1, wherein said end effector is configured to be detached fromsaid transducer, and wherein said transducer is configured to receive adifferent end effector.
 7. The surgical instrument of claim 1, whereinsaid clamp member comprises a jaw member and a jaw connector connectingsaid jaw member to a pivot, and wherein said jaw member is detachablefrom said jaw connector.
 8. The surgical instrument of claim 7, whereinsaid jaw member includes at least one deflectable leg, and wherein saidjaw connector includes a recess configured to receive said at least onedeflectable leg and retain said jaw member to said jaw connector.
 9. Thesurgical instrument of claim 1, wherein said proximal inner portiondefines a first perimeter, and wherein said first inner mating memberand said second inner mating member extend distally from first oppositeportions on said first perimeter.
 10. The surgical instrument of claim9, wherein said distal inner portion defines a second perimeter, whereinsaid third inner mating member and said fourth inner mating memberextend proximally from second opposite portions on said first perimeter.11. A surgical instrument, comprising: a transducer configured toproduce vibrations; an end effector operably engaged with saidtransducer, wherein said end effector defines an axis and a distal tip,and wherein said distal tip is movable relative to said axis by saidvibrations produced by said transducer; a clamp member, comprising: afirst connection portion; and a second connection portion spaced apartfrom said first connection portion; a tubular member comprising aproximal tubular portion and a distal tubular portion, wherein saidproximal tubular portion and said distal tubular portion are operablycouplable to each other, wherein said proximal tubular portion and saiddistal tubular portion are aligned with each other in a coupledconfiguration to permit the passage of said end effector through saidtubular member, wherein said proximal tubular portion comprises a firstproximal mating member and a second proximal mating member, wherein saiddistal tubular portion comprises a first distal mating member and asecond distal mating member, wherein said first proximal mating memberis releasably couplable to said first distal mating member, and whereinsaid second proximal mating member is releasably couplable to saidsecond distal mating member; and a connector assembly, comprising: afirst connector; and a second connector, wherein said first connector isconfigured to releasably and movably couple said first connectionportion of said clamp member to said tubular member and wherein saidsecond connector is configured to releasably and movably couple saidsecond connection portion of said clamp member to said tubular member.12. The surgical instrument of claim 11, wherein said vibrations includeat least one of vibrations parallel to said axis, vibrations transverseto said axis, and vibrations torsional about said axis.
 13. The surgicalinstrument of claim 11, wherein said clamp member further comprises ajaw member moveably supported relative to said end effector, whereinsaid jaw member is moveable between an open position and a closedposition.
 14. The surgical instrument of claim 11, wherein said endeffector is configured to be detached from said transducer, and whereinsaid transducer is configured to receive a different end effector. 15.The surgical instrument of claim 11, wherein said clamp member comprisesa jaw member and a jaw connector connecting said jaw member to a pivot,and wherein said jaw member is detachable from said jaw connector. 16.The surgical instrument of claim 15, wherein said jaw member includes atleast one deflectable leg, and wherein said jaw connector includes arecess configured to receive said at least one deflectable leg andretain said jaw member to said jaw connector.
 17. A surgical instrument,comprising: a transducer configured to produce vibrations; an endeffector engaged with said transducer, wherein said end effector definesan axis and a distal tip, and wherein said distal tip is movablerelative to said axis by said vibrations produced by said transducer; anactuator; a clamp member; an actuation member comprising a proximalactuation portion and a distal actuation portion, wherein said proximalactuation portion and said distal actuation portion are configured to becoupled to and decoupled from each other, wherein said clamp member isseparably couplable to said distal actuation portion, wherein saidproximal actuation portion is operably coupled to said actuator, whereinsaid proximal actuation portion comprises a proximal coupling means,wherein said distal actuation portion comprises a distal coupling means,and wherein said proximal coupling means is releasably coupled to saiddistal coupling means; and connector means configured to releasably andmovably couple said clamp member to said distal actuation portion ofsaid actuation member.
 18. The surgical instrument of claim 17, whereinsaid vibrations include at least one of vibrations parallel to saidaxis, vibrations transverse to said axis, and vibrations torsional aboutsaid axis.
 19. The surgical instrument of claim 17, wherein said clampmember further comprises a jaw member moveably supported relative tosaid end effector, wherein said jaw member is moveable between an openposition and a closed position.
 20. The surgical instrument of claim 17,wherein said end effector is configured to be detached from saidtransducer, and wherein said transducer is configured to receive adifferent end effector.
 21. The surgical instrument of claim 17, whereinsaid clamp member comprises a jaw member and a jaw connector connectingsaid jaw member to a pivot, and wherein said jaw member is detachablefrom said jaw connector.
 22. The surgical instrument of claim 21,wherein said jaw member includes at least one deflectable leg, andwherein said jaw connector includes a recess configured to receive saidat least one deflectable leg and retain said jaw member to said jawconnector.